The Mad Hatter: Have I gone mad?
Alice: I’m afraid so. You’re entirely bonkers. But I’ll tell you a secret: all the best people are.
– Alice In Wonderland
People who have had nasty stuff happen to them are likely to act a bit differently, particularly when placed under stress.
Some people who don’t act normally are called mentally ill, and given labels to say they have this or that disorder.
While there is utility in such arbitrary labels, it is clear that there are also counterproductive results.
For example not so long ago homosexuality was a mental illness, with it’s own symptoms and then it wasn’t. Just like that. Now it’s considered as normal and healthy. Even nostalgia was defined as an illness until recently. Again, whether delusions are considered problematic can be a grey area: “Delusions, in the medical sense, are not simply a case of being mistaken, as the everyday use of the term suggests. They are profound and intensely held beliefs that seem barely swayed by evidence to the contrary – even to the point of believing in the bizarre.” Religion is a great example of this, but we don’t pathologise such behaviour. The thing is, everyone holds some delusional beliefs – it’s part of the human condition.
It seems clear that psychiatry makes some of these judgements based on what is acceptable to society as much as what is unhealthy for the individual. It’s not exactly rigorous science. While there are biological markers for a few states of mind, for the majority there are not, so we resort to classifying behaviour. How do we define what behaviours are the results of “mental illness” and what are normal? One suggestion is defining the behaviour of the majority as the norm, and classifying everyone outside of that average as disordered. The faults with that approach are immediately clear. Another suggestion is whether that behaviour causes self harm. If so smokers, or those with a bad diet, are defined as mentally ill.
So we then look to the perceptions and feelings of the person. Phenomenology, is the best tool for this, but is again subjective and imprecise. We can also look at whether these behaviours affect a person’s ability to lead a normal life, which requires normality within their culture to be defined.
Of course there are many difficult conditions that one would have difficulty arguing against being classified as problematic in any society. I’m acutely aware that severe depression can be debilitating, that psychosis can mean a person is unable to care for themselves. I’ve seen it first hand. Mind says that 1 in 10 adults are experiencing depression at any one time. Over 10% of mothers experience post-natal depression. Around 1% of people experience bipolar symptoms at some point.
However, while these methods will have clearer conclusions at the extremes of behaviour, there are massive grey areas in between.
The conclusion then, is that this is not a simple, easily solvable area. An acceptance that we don’t have black and white definitions is necessary, much as that is not satisfying. And as a result we don’t have panaceas either.
Part II – The Drugs in the next post…